Transcript Arthroscopic Rotator Cuff Repairs

Arthroscopic Labral
Surgery
Presentation Designed For Patient Education
Updated 2/11
University Orthopaedics &
Sports Medicine
Offices
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Clifton (Medical Arts
Building)
Westchester
www.ucortho.com
513-475-8690
University Orthopaedics &
Sports Medicine
Surgery
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Holmes Hospital (Clifton)
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Mercy Fairfield
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Outpatient Surgery Center
Main
Outpatient Surgery Center
Westchester Medical Center
University Pointe Ambulatory Surgical Hospital (ASH)
University Hospital
What does the labrum do?
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Cartilage that surrounds
the glenoid (shoulder
socket)
Link between the socket
and the capsule (tissue
that holds the ball inside
the socket)
Deepens the socket and
is provides stability to
the shoulder
How is the labrum injured?
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Direct trauma to the
shoulder
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Motor vehicle accident
Sports
Fall
Shoulder dislocation
Pulling or pushing of
the arm
Repeated overhead
activity
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Athletes
Repetitive labor work
Labral Tears
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The labrum completely
surrounds the socket
The tears are described based
on their location
Tears in different locations
often give different symptoms
Superior labral anterior to
posterior (SLAP) tear
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Bankart tear
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Top of labrum frequently
involving the biceps tendon
Front, lower labrum
Posterior labral tear
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Back of labrum
What are the symptoms of labral injury?
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Pain
Feeling of instability
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“my shoulder is loose”
Locking
Clicking
Catching
Labral Tears-Diagnosis
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History
Physical Examination
X-rays
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MRI arthrogram
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Often normal
Radiologist injects dye into the
shoulder
MRI scan obtained
Best imaging test for labral
tears
MRI is not perfect—some
labral tears are not well seen
on MRI
Labral Tear
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Labral Tears-Non operative
treatment
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Anti-inflammatory medications-decreasing
inflammation causes decreased pain
Selective cortisone shots-steroids are very potent
anti-inflammatory medications and go directly
to the source with little systemic absorption
Physical Therapy-strengthening the rotator cuff
stabilizes the shoulder and may make the
shoulder feel better
These options are best for older patients with
degenerative type tears
Labral Tears-Surgery
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The most predictable option for treatment of
tears in a younger, active patient
Small frayed tears are best treated with
arthroscopic debridement
Large, unstable tears are best treated with
arthroscopic repair
Anesthesia
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Anesthesiologist administers
nerve block in pre-op
holding area after giving
some IV medications
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Typically lasts about 18 hours
General anesthesia
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Patient then placed under
general anesthesia
Patient is positioned such that
full access to the shoulder can
be obtained
Skin cleaned with sterilizing
prep
Athroscopic Surgery
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Arthroscopic
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Arthro = joint
Scope = camera
“Look around joint with
camera”
Arthroscopic Surgery
Normal Arthroscopic Anatomy
Labrum attaching to the bone
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The labrum surrounds
the socket and is
attached to the bone
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Biceps Tendon
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The biceps tendon
attaches to the labrum at
the top of the socket
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Labral Tears
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The instrument is in the tear
and the labrum has torn off
the bone
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If the labrum is torn at the
top of the socket then the
biceps can become unstable
causing pain and popping
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Instrument is under the labral
tear
Yellow arrow points to the
biceps tendon attached to the
torn labrum
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Labral Repair
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The labrum is sewn back
down to the bone using
implants called suture
anchors (special screws
with attached sutures)
The anchor goes into the
bone and the labrum is
sewn down with the
sutures
The suture holds the
labrum to the socket
until it heals
Labral Repair
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Suture anchor with
attached sutures
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Torn labrum
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Repaired labrum
Post op
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Wake up in a sling and cryocuff (ice pack)
If pre-op block was successful then you should
be pretty comfortable with a numb arm
Go home same day
Start taking your pain medications as soon as
you get home prior to your block wearing off.
It can be very difficult to “catch up” if you have
no pain medication in your system when your
block wears off.
Post-op-Medications
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Pain medications
Take these as needed
 Not well tolerated on an empty stomach so make
sure you eat something first even if just crackers
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Nausea medications
Sometimes patients are nauseated after surgery from
the anesthesia
 Usually wears off in 24 hours
 Can take medication if needed
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Post op
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Leave dressing intact for first 72 hours after surgery. Reinforce if
needed
May remove and shower at 72 hours post op
Do not scrub your wounds
Simply wash your neck with soap and water and let the soap and
water run off
Do not soak your wounds until permitted to do so by your
physician. NO BATH, SWIMMING OR HOT TUBS.
If your wounds are dry, may leave open to the air
If oozing then put on a clean dry dressing and call your doctor
Do not put any ointments on your wounds. This includes antibiotic
ointments (Neosporin, Polysporin, etc)
It is easiest to wear a button shirt
Wear your sling all the time except to shower
Post op
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Your first follow-up appointment should be 5-7
days post op
Please make an appointment to go to physical
therapy immediately following your first post op
appointment.
In some cases your surgeon may delay the start of
therapy for several weeks depending on the type of
tear
 The expected start date for therapy will be discussed
post-operatively
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Post-Op Rehab
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Start range of motion
exercises at 1 week
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Sling for 4-6 weeks
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Start strengthening at 812 weeks
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No sports, lifting for 4-6
months
Post-op Rehab
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IT IS ABSOLUTELY ESSENTIAL TO
PERFORM EXERCISES AT HOME AS
WELL AS IN THERAPY
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SOMETIMES IT IS NECESSARY TO DO
YOUR EXERCISES SEVERAL TIMES
DAILY
Frequently Asked Questions
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Will I have therapy post op?
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How long do I have to wear the sling?
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Yes. Initially 2-3 times per week then less often. Exercises
must be done at home too!
4-6 weeks. Longer when in an uncontrolled environment
When can I go back to work?
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This is highly variable depending on what you do
For desk jobs it could be as early as a couple days
Labor jobs with lifting, 4-6 months
Questions
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Any further questions should be directed to your
therapist or surgeon
Please call the office with questions or concerns
513-475-8690
www.ucortho.com
Thank You